At the ASM Microbe meeting in June, researchers from Gilead Sciences presented data on use of TDF/FTC (Truvada) PrEP in the United States according to sex and race. They evaluated national pharmacy databases to identify prescriptions of TDF/FTC given for PrEP between January 2012 and September 2015; they eliminated prescriptions given for ART, PEP, and HBV. They estimate that the data reviewed represents 82% of all retail pharmacies in the United States (so, this does not include data on PrEP obtained through sources such as research studies, demonstration projects, or nonretail pharmacies).

The study found that 49,158 persons started PrEP in this period of time, with a very sharp increase beginning in 2014 and a >500% increase over the entire period. However, the data also revealed sharp disparities in PrEP starts according to race, sex, and age. Data on race was available for about 44% of the study population--whites were given 74% of the PrEP prescriptions, Latinos 12%, African Americans 10%. In 2014, however, 44% of new HIV diagnoses occurred in African Americans and 23% in Latinos. Women made up 21% of PrEP starters overall, with no increase in numbers over time (new PrEP prescriptions were stagnant at about 2,500 per year). African American and Latino women had very low rates of PrEP initiation (more than 4 times less than in white women), while they comprised 62% and 16%, respectively, of new HIV infections in women in 2014. Similarly, <10% of PrEP prescriptions were given to young people <25 years of age, but 40% of new infections in 2014 occurred in those 13-29 years of age.

While these data do not fully reflect the PrEP landscape in the United States, they suggest both the encouraging prospect that PrEP uptake is increasing rapidly but also the stark indication that much more work is needed to get it to all populations at risk of HIV infection.